Transcript of "Utah Nutrition and Physical Activity Plan 2010-2020"

2.
Citation and Acknowledgements
The Utah Nutrition and Physical Activity Plan is a result of numerous individuals who devoted their time
and effort to the creation of this plan. This endeavor could not have happened without the hard work
and commitment that was displayed from public and private partners who worked through work groups
representing a variety of settings.
Special thanks goes to Karen Nellist for serving as the primary author of the plan.
Additional thanks to the Physical Activity, Nutrition, and Obesity (PANO) program staff:
Lynda Blades, Program Manager
Tania Charette, Media Coordinator
Patrice Isabella, Nutrition Coordinator
Brett McIff, Physical Activity Coordinator
Karen Nellist, Epidemiologist/Evaluator
Janet Scarlet, Administrative Assistant
All contributors (listed on pages 6 to 9) are owed a huge debt of gratitute for providing their time,
suggestions, and insights on addressing obesity in Utah and for providing feedback on drafts of this plan.
This plan was prepared by the Utah Department of Health with funding provided through
a Cooperative Agreement with the Centers for Disease Control and Prevention, Division of
Nutrition and Physical Activity (U58/DP001386).
This state plan may be reproduced and distributed without permission.
SuggeSted citation: Utah Nutrition and Physical Activity Plan 2010 to 2020. (2010) Salt Lake City,
Utah: Utah Department of Health.
Available for download at http://www.health.utah.gov/obesity.
RepoRt publiShed apRil 2010.
Some images in this document are the copyright property of Jupiter Images and are being used with permission under license.
These images and/or photos may not be copied or downloaded without permission from Jupiter Images.
Cover design and report layout by Spatafore and Associates, Salt Lake City, Utah.

13.
Utah Nutrition and Physical Activity Plan 2010-2020
I
n 2001, the Surgeon General issued a call to action to prevent and decrease
overweight and obesity in the United States. That document established
the “obesity epidemic” as the single greatest threat to the public’s health.
Currently an estimated 60.1% of Utah adults, or 1.1 million adults (2008 data)
are overweight or obese, and 19.7% of Utah elementary school students are either
overweight or obese.
The Surgeon General’s Call to Action established that for most Americans, this epidemic is, in part, a result
of unhealthy eating and sedentary behaviors. Overweight/obesity, physical inactivity and unhealthy eating
are associated with increased risk for heart disease; type 2 diabetes; endometrial, colon, postmenopausal
breast, and other cancers; stroke; hypertension; sleep apnea; gallbladder disease; osteoarthritis; depression;
and psychological difficulties due to social stigmatization.
The Utah Nutrition and Physical Activity plan 2010 to 2020 was developed under the direction of the
Utah Department of Health Physical Activity, Nutrition and Obesity (PANO) program and is a 10-year
action plan to reduce the burden of chronic diseases, such as obesity, in Utah through nutrition and
physical activity efforts. The purpose of the plan is to provide goals and strategies for government, media,
communities, health care providers, schools, and worksites that will impact overweight and obesity in
Utah. Partners representing many organizations, including local health departments, and other disciplines
participated in creating the goals and strategies found in the plan. Public and private partners will utilize
the plan for statewide planning, development, and implementation of physical activity and nutrition
interventions.
This plan presents opportunities to develop policies and modify our environment to enable Utah residents
to lead healthier lives. The plan provides Utahns with a range of opportunities for action. The development
of this plan demonstrates that working together to address the burden of chronic disease and obesity are the
first steps toward combating this problem in Utah.
Recommendations of this plan are focused on increasing healthy eating and physical activity and promoting
healthy lifestyles for all Utah residents. Based on recommendations from the Centers for Disease Control
and Prevention, the following target areas were identified:
• Increase physical activity
• Increase consumption of fruits and vegetables
• Decrease consumption of sugar-sweetened beverages
• Increase breastfeeding initiation, exclusivity, and duration
• Reduce the consumption of high-energy-dense foods
• Decrease television viewing time
The goals and strategies in the plan will be accomplished through the joint efforts of state and local
government agencies, nonprofit organizations, business leaders, health care providers and insurers, and
education organizations. The PANO program will play a leadership role in implementing the goals and
strategies and is committed to facilitating, supporting, and coordinating these efforts.
14 Executiv e Summ ary

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Utah Nutrition and Physical Activity Plan 2010-2020
T
he state plan is divided into seven chapters. Below is a list of all the sections
with a short description. The intent is that the state plan be used as a
reference document to help public and private partners understand the
issues, history, theories for change, the strength and use of partnerships, and specific
goals and strategies that can be used to effect change.
Description of the Obesity Epidemic in Utah
This section describes the obesity epidemic in Utah using current surveillance data. Body Mass Index (BMI)
is defined; surveillance data for nutrition and physical activity are included, and the interaction of obesity
and chronic diseases is described. Health disparities are addressed by reviewing data on race/ethnicity, age/
sex, and geography. This section serves as a snapshot to describe the obesity epidemic in Utah.
History of Obesity Prevention in Utah
The history of obesity prevention in Utah is discussed in detail including the first obesity report issued
by the Utah Department of Health, the publication of the Utah Blueprint, the establishment of the Utah
Partnership for Healthy Weight and the Utah Physical Activity, Nutrition, and Obesity (PANO) program.
This section describes how we got where we are today and the organization that will carry us into the future.
Planning for Change
Theory and models describe how environmental and policy change result in decreased prevalence of obesity.
The six target areas are described and priority populations are identified. A brief description on how physical
activity and nutrition intervention will be selected is included. This section identifies how the theories and
models will effect change.
Planning Through Partnerships
This section identifies a Utah-specific plan on how to maximize partnerships to achieve broad reaching
environmental and policy change. The statewide structure and organization is described, including the
establishment of six work groups (government, media, health care, school, community, and worksite).
Each of the work groups participated in the creation of the goals and strategies contained in the state plan,
and they each have a detailed plan on how to implement the strategies in order to achieve the goals.
16 Introduction: How to Use The Plan

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Utah Nutrition and Physical Activity Plan 2010-2020
Goals and Strategies
This is the main part of the plan and includes goals and strategies created by each work group. The goals
and strategies help work group members focus their efforts around environment and policy change. The
section also includes the overarching goal, “To decrease childhood, youth, and adult overweight and obesity
in Utah.” A summary of Healthy People 2010 goals relevant to physical activity, nutrition, and obesity are
also listed along with Utah baseline and current rates.
Implementing the Plan
This section includes a call to action, a description of how to become involved in this growing movement,
and a plan on how to leverage human and financial resources to make lasting changes.
Measuring Progress
Surveillance and evaluation are a key part of planning and this section describes how current and future
surveillance systems will be incorporated into a surveillance plan.
Introduction: How to Use The Plan 17

18.
The Easy Choice
Description of the
Obesity Epidemic in Utah
Epidemic

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Utah Nutrition and Physical Activity Plan 2010-2020
The Obesity Epidemic
Obesity in the United States has reached epidemic proportions. Since the mid-1970s, the prevalence of
overweight and obesity has increased sharply for both adults and children. Data from a national survey
(NHANES) show that among adults aged 20-74 years, the prevalence of obesity increased 125% (from
15% in 1976-1980 to 33.8% in 2007-2008).1 This survey also shows an increase in obesity among children
and teens. For children aged 2-5 years, the prevalence of obesity increased 108% (from 5.0% to 10.4%),
for those aged 6-11 years the prevalence increased 201% (from 6.5% to19.6%), and for those aged 12-19
years the prevalence increased 262% (from 5.0% to 18.1%).2
This dramatic increase in obesity rates has serious implications for the health of Americans today and into
the future. Being overweight or obese increases the risk of many diseases and chronic health conditions and
the related cost to the health care system has been estimated to exceed $100 billion.3 Nutrition and physical
activity are thought to play a critical role in reducing the rates of overweight and obesity.
1. Flegal, KM, Carroll, MD, Ogden, CL, Curtin, LR (2010) Prevalence and trends in obesity among US Adults, 1999-2008. JAMA. ..........
2010;303(3):235-241. Published online January 13, 2010. Retrieved on March 1, 2010 from
http://jama.ama-assn.org/cgi/content/full/303/3/235?ijkey=ijKHq6YbJn3Oo&keytype=ref&siteid=amajnls.
2. Ogden, CL, et al. (2010) Prevalence of High body mass index in US children and adolescents, 2007-2008. JAMA. 2010;303(3):242-249. .
Published online January 13, 2010. Retreived on March 1, 2010 from http://jama.ama-assn.org/cgi/content/full/303/3/242?ijkey=ImvVL7s53
Zyps&keytype=ref&siteid=amajnls
3. DHHS. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Washington, DC: US Government
Printing Office, 2001:16. (On-line Access) http://surgeongeneral.gov/topics/obesity.
What is Body Mass Index (BMI)?
Obesity and overweight are commonly defined in terms of the body mass index (BMI). BMI is calculated
using a person’s height and weight. In adults, a BMI of 18.5 to 24.9 is considered to be ideal, and anything
above this is defined as overweight; a BMI of 30 or greater is considered obese. For children, between
the ages of 2 and 20 years, obese is defined as at or above the gender- and age-specific 95th percentile of
BMI based on published growth charts. Overweight is defined as between the 85th percentile and 95th
percentiles. See Table 1 for a listing of all BMI categories.
The BMI indicator is not a perfect indicator of individual health since it can be influenced by body frame
size. People with stockier builds (i.e., heavier body frames) may be considered overweight even if they don’t
have a lot of body fat. Conversely, a person with a smaller frame size may be considered to be at a healthy
weight but they might have a higher percentage of body fat. Though BMI might not be as accurate as body
Table 1: BMI Categories by Age Group
Age Group BMI Category BMI Values How Calculated
Underweight Less than 18.5 Calculated using the
Adults 21+ following formula:
Ideal Weight 18.5 to 24.9
Years of Age  weight ( pounds ) 
Overweight 25 to 29.9 BMI = 
 height (inches) × height (inches)  × 703

Obese 30 or higher  
Underweight Less than15th percentile
Children 2 to 20 Ideal Weight Between 15th to 85th percentile Calculated using the revised CDC
Years of Age Growth Charts for the US
Overweight Between 85th to 95th percentile
Obese 95th percentile or higher
20 Descr iption of the Obesit y Epidemic in Utah

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Utah Nutrition and Physical Activity Plan 2010-2020
Figure 1: Percentage of Obese Adults Over Time, Utah and US
30
25
20
Percentage
15
Utah US
10
5
0
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Source: BRFSS, age-adjusted to the 2000 US population
fat percentage at measuring individual health, BMI is used in this report because it is the best method to
measure changes in body mass in populations over time.
The percentage of obese adults has risen over time. See Figure 1. In 1989, 10.4% of Utah adults were obese
and by 2008, the Utah obesity rate had more than doubled to 24.0%.
The percentage of Utah adults at an unhealthy weight (either overweight or obese) has risen from 39.3%
in 1989 to 60.1% in 2008, a 53% increase in 20 years. The percentage of overweight adults has risen 25%
whereas the percentage of obese adults has risen 130%—more than double.
The Centers for Disease Control and Prevention has identified six target areas that have the potential to
effect statewide obesity rates. These target areas are based on the current, emerging, or promising evidence
that most likely impact overweight and obesity. The six target areas are: increasing physical activity;
increasing consumption of fruits and vegetables; decreasing consumption of sugar-sweetened beverages;
increasing breastfeeding initiation, exclusivity, and duration; reducing consumption of high-energy-dense
foods, and decreasing television viewing. The remainder of this section displays Utah data for the six target
areas, for the association between obesity and chronic conditions, and for the association between obesity
and demographic characteristics.
“As we look to the future and where childhood obesity will
be in 20 years…it is every bit as threatening to us as is the
terrorist threat we face today. It is the threat from within.”
Dr. Richard Carmona, Former US Surgeon General 2002-2006
Descr iption of the Obesit y Epidemic in Utah 21

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Utah Nutrition and Physical Activity Plan 2010-2020
BMI of Utah Children Figure 2: Percentage of Utah Children
(3rd Graders) at an Unhealthy Weight, Over Time
The percentage of Utah third graders who were
at an unhealthy weight (overweight or obese) 20
Obese Overweight
in 1994 was 16.7%. By 2008 that rate had
increased to 19.7%, an 18% increase. However, 15
the rate of obesity had risen from 5.9% in
Percentage
1994 to 8.6%, a 46% increase; there was no 10
statistical difference between the obesity rate for
2006 and 2008. It is unclear whether the rate 5
of overweight and obesity in third graders is
continuing to increase or is leveling-off. 0
1994 2006 2008
Source: Utah Children Height/Weight Study
BMI of Utah Youth Figure 3: Percentage of Utah Youth (High School
Students) at an Unhealthy Weight, Over Time
In 1999, 5.4% of Utah high school students
were obese and 9.1% were overweight based 20
Obese Overweight
on self-reported height and weight. In 2009,
15
6.4% of high school students were obese and
10.5% were overweight. Though the 2009 rates
Percentage
10
are higher than the 1999 rates, they are not
statistically different.
5
0
1999 2001 2003 2005 2007 2009
Source: YRBS
BMI of Utah Adults Figure 4: Percentage of Utah Adults at an
Unhealthy Weight, Over Time
The percentage of Utah adults who were obese
50 Obese Overweight
based on self-reported height and weight has
increased over time from 16.9% in 1999 to 40
24.0% in 2008. This represents a 42% increase
Percentage
in a 10-year period; the increase is statistically 30
significant. The percentage of Utah adults 20
who were overweight has remained constant
at around 36% over the same 10-year period. 10
This suggests that the increase in the percentage
0
of Utah adults at an unhealthy weight is being 1999 2001 2003 2005 2007 2008
driven by an increase in individuals who are
Source: BRFSS; age-adjusted to 2000 US population
obese, not individuals who are overweight.
22 Descr iption of the Obesit y Epidemic in Utah

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Utah Nutrition and Physical Activity Plan 2010-2020
Nutrition Figure 5: Percentage of Utah Youth who Eat 5
or More Fruits or Vegetables Per Day, Over Time
In 1999, 25.8% of Utah high school students ate
40
the nationally recommended amount of fruits
Boys Girls
or vegetables daily (5 or more per day). By 2009
that rate had decreased to 18.4%, representing 30
a statistically significant decrease of 29%.
Percentage
According to the data, boys ate numerically more 20
fruits or vegetables daily across all years though
these differences were not significant in any 10
measured year. The 2005 Dietary Guidelines for
Americans recommend that high school students 0
1999 2001 2003 2005 2007 2009
eat between 8 and 13 servings of fruits and
vegetables daily. Source: YRBS
Figure 6: Percentage of Utah Adults who Eat 5
In 1999, 21.1% of Utah adult males and 28.8% or More Fruits or Vegetables Per Day, Over Time
of females ate the nationally recommended 40
Males Females
amount of fruits or vegetables daily (5 per day); 35
females ate significantly more fruits or vegetables 30
compared to males. By 2007, there was no 25
Percentage
significant change in the percentage of fruits 20
or vegetables eaten by either males or females. 15
It is interesting to note that in the Utah adult 10
population a significantly higher percentage of 5
females ate the recommended amount of fruits 0
or vegetables compared to males at all time 1999 2003 2005 2007
points. No significant difference was seen in high Source: BRFSS; age-adjusted to 2000 US population
school students by sex.
Figure 7: Percentage of Utah Children who Were
Breastfed: Initiation, Duration, and Exclusivity
Breastfeeding 100
The most current data that represent the
Birth year=2000
percentage of Utah children who were breastfed 80 Birth year=2004
Birth year=2005
are from 2008, representing 2005 births. In
Percentage
60
general, over 80% of Utah children were ever
breastfed and over 50% of children have been 40
breastfed for at least 6 months and almost 24% 20
have been breastfed for 12 months. Ideally
all children would be exclusively breastfed for 0
Ever Breastfed Breastfed Exclusive at Exclusive at
at least 6 months. However, 19.1% of Utah Breastfed 6 Months 12 Months 3 Months 6 Months
children born in 2005 were exclusively breastfed Source: National Immunization Survey; 2000, 2004 and 2005
for 6 months. births. Exclusive breastfeeding data started with 2004 births
Descr iption of the Obesit y Epidemic in Utah 23

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Utah Nutrition and Physical Activity Plan 2010-2020
Physical Activity Figure 8: Percentage of Utah Youth who
Get the Recommended Amount of Physical
In 2005, 35.6% of Utah high school students Activity, Over Time
got the recommended amount of physical
70 Boys Girls
activity (60 minutes per day, 5 or more days of
60
the week). By 2009 the percentage had increased
to 47.3%, a significant increase. During the 50
Percentage
same time period, the percentage of girls who 40
got the recommended amount of physical 30
activity increased from 28.9% to 39.2% and the 20
percentage of boys who got the recommended
10
amount of physical activity also increased from
0
42.1% to 55.2%. At all time points, more 2005 2007 2009
boys got the recommended amount of physical
Source: YRBS
activity compared to girls.
Figure 9: Percentage of Utah Adults at an Unhealthy
The percentage of obese adult Utahns who got Weight who Get the Recommended Amount of Physical
Activity, Over Time
the recommended amount of physical activity
was 46.5% in 2001 compared to 42.6% in 70 Obese Overweight
2007; there was no statistical difference between 60
these two rates. The percentage of overweight
50
adult Utahns who got the recommended
Percentage
40
amount of physical activity was 49.0% in 2001
compared to 58.7% in 2007; this reflects a 30
statistically significant increase in the percentage 20
of overweight adult Utahns getting the 10
recommended amount of physical activity. 0
2001 2003 2005 2007
TV Screen Time Source: BRFSS; age-adjusted to 2000 US population
Overall, Utah children watch more television
on the weekends compared to the weekdays. Figure 10: Percentage of Utah Children who Get
On weekdays, a higher percentage of 13-17 year 2 or More Hours of Combined Screen Time, 2007-2008
old males (44.7%) had two or more hours of
combined screen time (TV and video gaming) 100 5-8 years 9-12 years 13-17 years
compared to females (33.5%). On the weekend, 80
a higher percentage of males aged 9-12 years
Percentage
60
(85.8%) and 13-17 years (85.6%) had two or
more more hours of screen time compared to 40
those aged 5-8 years (75.8%). On the weekends, 20
a higher precentage of females aged 9-12 years
0
(81.1%) had two or more hours of combined Weekday Weekend Weekday Weekend
screen time compared to those aged 5-8 years Boys Girls
(68.8%) and 13-17 years (79.1%).
Source: BRFSS, Utah Child-Selection Module.
24 Descr iption of the Obesit y Epidemic in Utah

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Utah Nutrition and Physical Activity Plan 2010-2020
Obesity and Chronic Diseases
Overweight and obesity are associated with chronic diseases such as diabetes, hypertension, stroke, heart
disease, arthritis, asthma, and some cancers.
Obesity is a major risk factor for type 2 diabetes. Type 2 diabetes is often considered a lifestyle disease and
is associated with overweight and obesity, physical inactivity, and poor dietary habits. The prevalence of
diabetes is dramatically higher in overweight and obese people. Likewise, diabetes increases an individual’s
risk of heart disease, stroke, and is a leading cause of blindness and lower-limb amputation. Type 2 diabetes,
once considered an adult disease, is now also seen in children. It is estimated that almost one-half of all new
childhood diabetes cases are classified as type 2.
Being overweight or obese increases an individual’s risk for high cholesterol, hypertension (high blood
pressure), cardiovascular disease, angina, heart attack, and stroke. The prevalence of high cholesterol is
greater in overweight and obese adults than those at ideal weight. This is also true of hypertension.
Being overweight or obese increases the risk for certain types of arthritis. Specifically, osteoarthritis, a slowly
evolving degenerative disease, is prevalent in overweight and obese adults. The relationship between obesity
and osteoarthritis is explained as follows: 1) a person who is overweight or obese has increased force exerted
on their joints which may result in a breakdown of cartilage, and 2) an overweight or obese person may
have increased bone mineral density which is a risk factor for osteoarthritis.
Asthma is more prevalent in obese adults compared to those at an ideal weight. It is unclear whether asthma
leads to obesity due to of lack of exercise and subsequent weight gain, or vice versa.
Obesity is associated with cancers of the colon, breast, endometrium (lining of the uterus), kidney,
and esophagus. Obesity is also associated with Hodgkin’s disease in males and non-Hodgkin’s lymphoma
in females.
Arthritis Figure 11: Percentage of Utah Adults with Doctor-
Diagnosed Arthritis by BMI Weight Category, 2007
Adult Utahns at ideal weight have an arthritis
40
prevalence rate of 20.8%, those who are
overweight have a rate of 22.4%, and those who
30
are obese have a rate of 34.7%. The percentage
Percentage
of obese Utahns with arthritis was significantly
20
higher than either those at ideal weight or
overweight. Approximately 160,000 obese adult
10
Utahns have arthritis.
0
Ideal Weight Overweight Obese
Source: BRFSS; age-adjusted to 2000 US population
Descr iption of the Obesit y Epidemic in Utah 25

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Utah Nutrition and Physical Activity Plan 2010-2020
Asthma Figure 12: Percentage of Utah Adults with Current Doctor-
Diagnosed Asthma by BMI Weight Category, 2008
Adult Utahns at ideal weight have a current
asthma prevalence rate of 6.7%, those who are 40
overweight have a rate of 7.2%, and those who
are obese have a rate of 12.8%. The percentage 30
of obese Utahns with current asthma was
Percentage
significantly higher than either those at ideal 20
weight or overweight. Approximately 59,000
obese adult Utahns have current asthma. 10
0
Ideal Weight Overweight Obese
Source: BRFSS; age-adjusted to 2000 US population
Depression Figure 13: Percentage of Utah Adults with Major
From 2005 to 2008, the Patient Health Depression by BMI Weight Category, 2005-2008 Combined
Questionnaire (PHQ9), which measures
10
major depression, was administered as part of
the Utah Behavioral Risk Factor Surveillance 8
System (BRFSS). Adult Utahns at ideal weight
have a major depression prevalence rate of
Percentage
6
3.4%, those who are overweight have a rate of
4
3.8%, and those who are obese have a rate of
5.8%. The percentage of obese Utahns with 2
major depression was significantly higher than
either those at ideal weight or overweight. 0
Ideal Weight Overweight Obese
Approximately 27,000 obese adult Utahns have
major depression. Source: BRFSS; age-adjusted to 2000 US population
Figure 14: Percentage of Utah Adults with
Diabetes Doctor-Diagnosed Diabetes by BMI Weight Category,
2006-2008 Combined
Adult Utahns at ideal weight have a diabetes 20
(type 1 and type 2 combined) prevalence rate
of 3.2%, those who are overweight have a rate
15
of 6.0%, and those who are obese have a rate
of 13.3%. The percentage of obese Utahns
Percentage
with diabetes was significantly higher than 10
either those at ideal weight or overweight.
Approximately 63,000 obese adult Utahns have 5
diabetes.
0
Ideal Weight Overweight Obese
Source: BRFSS; age-adjusted to 2000 US population
26 Descr iption of the Obesit y Epidemic in Utah

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Utah Nutrition and Physical Activity Plan 2010-2020
Health Disparities Figure 15: Percentage of Utah Adults
at an Unhealthy Weight by Race, 2004-2008 Combined
Race/ethnicity 60
Obese Overweight
Significantly more American Indians/Alaskan 50
Natives (46.5%) are overweight compared to
40
Whites (35.7%) and significantly fewer Asians
Percentage
(28.6%) are overweight compared to Whites. 30
Significantly more Blacks (36.9%), Pacific 20
Islanders (46.9%), and American Indian/Alaskan 10
Natives (31.1%) are obese compared to Whites, 0
(22.3%) and significantly fewer Asians (10.6%) White Black Asian Pacific American Other
Islander Indian/AK
are obese compared to Whites (22.3%). Native
Source: BRFSS; age-adjusted to 2000 US population
Significantly more Hispanics were at an Figure 16: Percentage of Utah Adults
at an Unhealthy Weight by Ethnicity, 2008
unhealthy weight (69.1%) compared to White
Non-Hispanics (58.9%). This is due to the 60
Obese Overweight
higher percentage of overweight Hispanics
50
(45.1%) compared to White Non-Hispanics
(35.1%). There was no statistically significant 40
Percentage
difference between the percentage of Hispanics 30
(23.9%) who were obese compared to White
20
Non-Hispanics (23.8%) who were obese.
10
0
White-Non Hisp Hispanic Non-W,Non-Hisp
Source: BRFSS; age-adjusted to 2000 US population
age/Sex Figure 17: Percentage of Utah Adults at an Unhealthy
In all but the 18 to 24 and 75+ age groups, adult Weight by Age and Sex, 2008
males had a significantly higher percentage of 100 Males Females
unhealthy weight compared to females. The
80
percentage of obese males and females was not
significantly different across all age groups.
Percentage
60
Thus, the significant difference in the unhealthy
40
weight rates by sex is being driven by the rates
of overweight across age and sex. There was 20
a significant difference in the overall rate of
0
unhealthy weight by sex: males (65.1%) and 18-24 25-34 35-44 45-54 55-64 65-74 75+
females (50.9%). The difference was driven by Age in Years
the rates of overweight across sex.
Source: BRFSS, 2008
Descr iption of the Obesit y Epidemic in Utah 27

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Utah Nutrition and Physical Activity Plan 2010-2020
History of Statewide Obesity Prevention
The first comprehensive obesity report focusing on the obesity epidemic in Utah was published by the Utah
Department of Health (UDOH), Bureau of Health Promotion (BHP) in August 2005. Later that month,
the Utah Childhood Obesity Forum was held. The purpose of the Forum was to bring together health and
other professionals who had an interest and/or a potential influence in childhood obesity. The working
meetings at the Forum resulted in a listing of possible strategies that could be implemented to reduce obesity
in one of seven settings: Community, Family, Government, Health Care, Media, School, and Worksite.
From this listing, the Utah Blueprint to Promote Healthy Weight for Children, Youth, and Adults was
developed and published in May 2006. In September 2006, Governor and Mrs. Huntsman hosted Governor
Huntsman’s Kick-Off to Promote Healthy Weight at the Governor’s mansion.
Since UDOH did not have dedicated staff or funding for obesity prevention, an internal work group was
formed within the health department. In 2006, UDOH participated in the establishment of a statewide
coalition of private and public partners called the Utah Partnership for Healthy Weight (UPHW).
More information about the UPHW is found on the next page. In 2008, representatives of the Healthy
Weight Work Group within UDOH, BHP applied for and received funding from the Centers for Disease
Control and Prevention. The CDC Cooperative Agreement, which started in 2008, allows for five years of
funding to establish a statewide Physical Activity, Nutrition, and Obesity Program (PANO) housed within
UDOH, BHP for statewide capacity building. In 2008, a comprehensive list of state and local agencies
focusing their efforts on healthy weight was created. See Appendix.
2006 Blueprint Vision
The healthy choice is the easy choice
at home, school, work, and play in Utah.
30 History of Obesit y Pr ev ention in Utah

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Utah Nutrition and Physical Activity Plan 2010-2020
The Utah Partnership for Healthy Weight (UPHW)
The Utah Partnership for Healthy Weight is a nonprofit corporation and public-private partnership of over
35 Utah organizations working to combat obesity in Utah.
What We do:
• Work to implement the Utah Blueprint and successor plans
• Advocate for healthy weight and obesity prevention with government and the general public
• Act as clearinghouse for healthy-weight resources and programs
• Coordinate fragmented Utah healthy-weight efforts
• Act as a resource for persons and organizations interested in healthy weight
• Collaborate with Utah universities on healthy weight research
• Fund healthy weight intervention and research projects
• Seek funding to promote healthy weight in Utah
Partnership members meet quarterly and bring together leaders in Utah committed to implementing the
Blueprint and successor plans in a comprehensive, coordinated approach. By successfully combatting
overweight and obesity, we will help Utahns and others enjoy a better quality of life and reduce the growing
financial burden of medical care and services.
UPHW Vision: Reshaping Utah
until the healthy choice is an
easy choice at home, school, work, and play.
Time Line of Signi cant Utah Obesity-Related Activities (2005 to present)
2005 Publication of Tipping the Scales: Toward a Healthier Population: A Report of Overweight and Obesity in Utah
2005 Utah Childhood Obesity Forum held at the Delta Center
2005 Formation of UDOH, Bureau of Health Promotion Healthy Weight Work Group
2006 Publication of Tipping the Scales: Toward a Healthier Population: The Utah Blueprint to Promote Healthy
Weight for Children, Youth, and Adults
2006 Governor and Mrs. Huntsman host Governor Huntsman’s Kick-Off to Promote Healthy Weight
2006 Formation of the Utah Partnership for Healthy Weight a.k.a BeeWell Utah
2007 Utah Partnership for Healthy Weight received tax-exempt status as a 501 (c) 3 organization
2008 UDOH applied for CDC Cooperative Agreement Funding to support PANO Program
2008 UDOH awarded CDC Cooperative Agreement Funding; PANO Program established
2009 Obesity State Plan Forum held at Larry H. Miller Community College Campus
2010 Publication of Utah Physical Activity and Nutrition 10-Year State Plan 2010 - 2020
History of Obesit y Pr ev ention in Utah 31

31.
Utah Nutrition and Physical Activity Plan 2010-2020
The UDOH Physical Activity, Nutrition,
and Obesity (PANO) Program
The PANO Program was established within the Utah
Department of Health’s (UDOH) Bureau of Health
Promotion in 2008. A 5-year Centers for Disease Control
and Prevention cooperative agreement provided funding
to build state-level capacity for obesity prevention.
The PANO Program works with public and private partners associated with the Utah Partnership for
Healthy Weight. One of the major goals of the PANO program is to create a 10-year state plan that
serves as a guiding document for the next ten years. The plan includes goals and strategies which have
been prioritized by time (short term: 1-2 years; intermediate term: 3-5 years; and long term: 5+ years).
Additionally, a 2009-2010 implementation plan was written by each work group, identifying goals,
strategies, and measurable and time bound for completion. The PANO program facilitates this process.
Implementation plans will be evaluated and updated annually.
The PANO Program partners with local health departments, other state public agencies, and nonprofit
and private organizations to implement the goals and strategies identified in the state plan.
PANO Mission Statement:
To engage public and private partners in promoting healthy behaviors including regular physical activity
and good nutrition by developing supportive environments to improve the health and quality of life for
people in Utah. We influence change within: schools, worksites, communities, health care, media, and
government.
PANO Vision: A State where
people maintain a healthy weight
through good nutrition and physical
activity because the healthy
choice is the easy choice at home, school,
work, and in communities.
32 History of Obesit y Pr ev ention in Utah

33.
Utah Nutrition and Physical Activity Plan 2010-2020
Theories of Change
The Utah Physical Activity, Nutrition, and Obesity Program (PANO) provides a statewide focus for
overweight and obesity prevention and management through increased physical activity and improved
nutrition. The adapted social-ecological model (below) was used as the framework for developing the
10-year state plan. Additionally, a logic model was developed to describe the relationships between resources,
activities, and results (next page) and to integrate the planning, implementation, evaluation, and reporting.
The Social-Ecological Model (SEM) describes how health promotion includes not only individual behavior
change but also organizational, community, and environmental change, policy development, and economic
supports. At the center of the model is the individual with their awareness, knowledge, attitudes, and
behaviors. This is the foundation, but there are many different external forces at play (all the other layers of
the model). In order to facilitate individual behavior change, it is important to address the external forces.
The 10-year state plan is designed to change the institutional/organizational, community, and public policy
layers of the model. Changing these layers will lead to an environment where individual behavior change is
easier and can be sustained long-term.
Adapted Social-Ecological Model
Adapted Social-Ecological Model for Levels of Influence
Public Policy Public Policy:
Government Work Group local, state, and federal
government policies, regulations, and laws
Community Community:
Community Work Group social networks, norms, standards, and
practices among organizations
Institutional/Organizational Institutional / Organizational:
Health Care, Schools, and rules, policies, procedures, environment,
WorksitesWork Group and informal structures within an
organization or system
Interpersonal
Interpersonal:
family, friends, peers, that provide social
identity, support and identity
Individual Individual:
awareness, knowledge, attitudes, beliefs,
values, and preferences
Adapted from McElroy KR, Bibeau D, Steckler A,
Glantz K. An ecological perspective on health
Media is an area of influence at all levels promotion programs. Health Education Quarterly
15:351-377, 1988.
34 Planning for Change

35.
Utah Nutrition and Physical Activity Plan 2010-2020
Six Target Areas and Priority Populations
Six Target Areas
The Centers for Disease Control and Prevention has identified six target areas for state obesity prevention
programs. These target areas are based on the current and emerging or promising evidence that most likely
impact overweight and obesity. The target areas include:
• Increase Physical Activity
Changing physical activity behaviors requires an understanding of how factors at each level of the
social-ecological model affect an individual’s physical activity behaviors. Therefore, understanding the
determinants of physical activity becomes the cornerstone in setting policies, recommendations, and
guidelines that better enable individuals and communities to engage in physical activity as part of a
healthful lifestyle and helps to guide the development, implementation, and evaluation of interventions.
• Increase Consumption of Fruits and Vegetables
Public health approaches for eating behavior change in populations have focused on increasing individual
knowledge and awareness through educational approaches. Many barriers prevent adequate consumption
of fruits and vegetables including lack of knowledge about health benefits, availability, cost, individual
taste preference, social support, preparation skills, and time available for preparing food. Studies also
show disparities in access to fruits and vegetables as measured by type of stores, geographic distance, or
store concentration. Choosing healthy foods is difficult in environments where retail establishments are
comprised mainly of convenience stores and fast food restaurants or for individuals dependent on public
transportation for supermarket access.
• Decrease Consumption of Sugar-Sweetened Beverages
Potential health problems associated with high intake of sugar-sweetened beverages include weight gain,
overweight, or obesity as a result of additional calories in the diet, displacement of milk consumption
which can contribute to reduced calcium intake with an attendant risk of osteoporosis and fractures,
displacement of other key nutrients, and dental caries/potential enamel erosion. Environmental changes
in homes, communities, workplaces, and schools include making water and low-calorie beverages the easy
choice by ensuring that they are available and limiting access to sugar-sweetened beverages.
• Increase Breastfeeding Initiation, Exclusivity, and Duration
Many barriers make it difficult for mothers to meet their breastfeeding goals. Routine practices in
hospitals often interfere with establishment of early breastfeeding. Mothers often do not receive or have
access to support from health care professionals when they encounter difficulties with breastfeeding.
Mothers encounter social disapproval from society when they choose to breastfeed in public places. When
they choose to work outside the home, they encounter rigid schedules, lack of support from employers
and coworkers, and difficulties in finding the time to breastfeed or express milk for their infants.
36 Planning for Change

36.
Utah Nutrition and Physical Activity Plan 2010-2020
• Reduce the Consumption of High-Energy-Dense Foods
The current food supply contains a significant amount of high-energy-dense foods. Many of these are
processed foods that are high in fat and/or sugar and low in nutrients. Portion sizes have also increased
over the past two decades in restaurants, grocery stores, and vending machines. Portion sizes for
manufactured and restaurant foods in the U.S. increased dramatically in the 1980s, and have continued to
grow gradually. Promising strategies to decrease high-energy-dense food consumption include substituting
low-energy-dense foods, decreasing the portion size of high-energy-dense foods, and limiting the
availability of high-energy-dense foods.
• Decrease Television Viewing
Watching television is common in most U.S. households, and many children and adults enjoy watching
television, not perceiving the amount of time they watch as a problem. There also is substantial confusion
as to what television limits would entail and what “counts.” Reducing television time would require
parents to find alternative activities to keep children safe and quietly engaged, and it could also prevent
parents from accomplishing other tasks, increase conflict between parents and children or between
siblings, and would require parents to change their own television viewing behavior.
Priority Populations
Priority populations include those where the burden of disease is highest (based on data), those that
have historically been disenfranchised, and those with limited access to resources due to geographic or
socioeconomic factors.
P R i o R i t y P o P u l a t i o n S i n c l u d e , b u t a Re n o t l i m i t e d t o :
• Children
• Elderly
• Clinically depressed children, youth, and adults
• People with disabilities
• Socioeconomically disadvantaged people
• People who live in rural and frontier areas
• Race/ethnic minorities
• Refugees
Results of recent focus groups conducted in different geographic regions of Utah, showed that different
race/ethnic groups have differing opinions of what is healthy, what constitutes physical activity, and what
interventions would mesh with their overall culture. It became apparent that matching interventions with
the geographical and cultural norms will be critical to optimize permanent change. Social marketing and
key informant interviews with individuals in the community will lead to important information to target
appropriate interventions.
Assessment of resources and gaps in existing programs relevant to priority populations will be identified.
Planning for Change 37

37.
Utah Nutrition and Physical Activity Plan 2010-2020
How to Select Interventions
Public health practitioners, community organizations, and others can implement interventions at every level
of the Social-Ecological Model (societal, community, organizational, interpersonal, and individual levels).
Interventions to prevent and control obesity should include an approach that creates environments, policies,
and practices that support both an increase in physical activity and an improvement in dietary behaviors
within the target population. Interventions that are multi-component (education with skill building,
creating access with campaigns for awareness, etc.) go beyond the population acquiring new knowledge and
toward building skills and practicing the desired behavior. Approaches and interventions selected should
be determined only after assessment of the target population. Further assessment of the target population
and their needs, barriers, and goals will point to the most appropriate intervention to reach the target
population’s nutrition and physical activity goals.
Interventions will be implemented primarily at the local level through partnerships with local health
departments, community organizations, and other public, private, and nonprofit organizations. Local
partners will be included in prioritization and implementation of local interventions. The PANO Program
will coordinate and facilitate these initiatives.
When selecting interventions the
following criteria will be considered
• Availability of evidence-based interventions
• Effectiveness of intervention
• Consideration of available social marketing data
• Age, gender, culture, and other relevant social data about the target population
• Burden of disease in target population
• Readiness for change of target population
• Sustainability of intervention
• Integration of intervention with existing programs that focus on chronic diseases,
prevention, education, and service delivery
• Priority populations and sub-groups
38 Planning for Change